Term paper Week 1 – Intro to Health Care

This course’s term project will be a Reflection Journal. From week 1 to week 7 in this course, you will engage your thoughts and abilities as a scholar. You will write at least 200 words (by the end of each week), reflecting on what you learned during the course of the week, from the discussions, the reading, class assignment, and participation. Further, include your feelings, and personal thoughts. It is your opportunity to reflect on your past week.

At the end of week seven, your journal will include seven entries, all tying to course material. After you finish your week 7 entry, post another paragraph of at least 150 words and reflect on the course in its entirety. What did you feel was most beneficial? What personal connections were you able to make during the seven weeks? What skills did you obtain that will benefit you in your career field? 

Also, feel free to add anything else about the course and its content.

health care

Overview of U.S. Healthcare System

Did you know?
When the practice of medicine first began, tradesmen such as barbers practiced medicine.
They often used the same razor to cut hair as to perform surgery.
In 2010, the United States spent $2.6 trillion on healthcare spending or 17.6% of the gross domestic product, which is the highest in the world.

Interesting Facts
CMS predicts annual healthcare costs will be $4.64 trillion by 2020, which represents nearly 20% of the U.S. gross domestic product.
The US is one of only a few developed countries that does not have universal healthcare coverage.
In 2002, the Joint Commission issued hospital standards requiring them to inform their patients if their results were not consistent with typical care results.

Summary
This textbook provides information for you as both a health care consumer and an employee of the health care industry.
provides an overview of the history of the four major sectors of health care:
traditional medicine and medical education
hospital system development
public health
health insurance
These sectors will be discussed in depth throughout the book.

Summary
The U.S. healthcare system is one of the most expensive and complex systems in the world.
Both government and private participation in healthcare
According to 2010 statistics, the US spent $2.6 trillion on healthcare expenditures, or 17.6% of its gross domestic product
This is an expensive system, but we are not at the top worldwide with life expectancy rates and infant mortality rates.

Basic Concepts of Health
Before we discuss the system, it is important to remember these three concepts of how health care is provided to consumers.
Primary prevention avoids the development of a disease. Examples include:
smoking cessation programs
immunization programs, and
educational programs for pregnancy and employee safety.

Basic Concepts of Health
Secondary prevention activities are focused on early disease detection, which prevents progression of the disease.
Screening programs, such as high blood pressure testing, are examples of secondary prevention activities.
Colonoscopies and mammograms are also examples of secondary prevention activities.

Basic Concepts of Health
Tertiary prevention reduces the impact of an already established disease by minimizing disease-related complications.
Tertiary prevention focuses on rehabilitation and monitoring of diseased individuals.

Government Participation
There are several federal agencies responsible for enforcing rules and regulations such as:
Food and Drug Administration
Centers for Medicaid and Medicare Services
Agency for Healthcare Research and Quality
Center for Mental Health Services

Private Participation
Healthcare costs are paid by a health insurance plan, private, or government, and the enrollee of the plan.
Most consumers cost share in their healthcare coverage.
Nearly 60% of health insurance coverage is through an employer plan

Social Legislation
Social regulations: rules and regulations that protect consumers
Sherman Antitrust Act
Newborns’ and Mothers’ Health Protection Act
Women’s Health and Cancer Rights Act
Mental Health Parity Act
Genetic Information Nondiscrimination Act
Lilly Ledbetter Fair Pay Act
Affordable Care Act

Table 1-1

Table 1-1 (cont’d)

Table 1-2

Table 1-2 (cont’d)

Table 1-3

Table 1-3 (cont’d)

Table 1-4

Table 1-4 (cont’d)

Table 1-4 (cont’d)

Milestones of U.S. Healthcare
Let’s review each table and discuss the important events of each system component
Activity: Which milestones stand out for you and why?

Figure 1-1

Iron Triangle
A balancing act of access, cost containment and quality.
The Iron Triangle focuses on quality, cost and access of a program.
The quality of the service, the cost of the service and the accessibility of the service must be balance in order to provide a good health care.
Activity: Give me an example of how an imbalance could occur

Iron Triangle Balance Issues
It is important that the three points of the triangle are balanced or there may be a problem.
If an increase in cost is emphasized, there may be a decrease in access to affordable health care.
If a decrease in cost is emphasized, quality may suffer.

Conclusion
No universal healthcare coverage in the U.S.
Health disparities across the nation
Most expensive healthcare system in the world
Nearly 50 million are uninsured
Both government and private participation in healthcare

Conclusion
Most individuals receive health insurance from employers
ACA was very divisive across political parties
ACA focus is increasing access to healthcare and improving quality
ACA mandate of individual healthcare mandate should decrease the number of uninsured

Impact of the Affordable Care Act

Did You Know?
The ACA requires most U.S. citizens and legal residents to purchase health insurance if they can afford it or pay a penalty.
The ACA mandates that every state create a consumer-oriented marketplace where individuals are provided information and can purchase healthcare insurance.
The ACA bans health plans from establishing lifetime dollar limits on healthcare insurance reimbursement.

Did You Know?
The new Independence at Home program provides an opportunity for the chronically ill to be treated at home.
The ACA established the Medicare and Medicaid Innovation Center, which provides opportunities for innovative healthcare research.
The Elder Justice Act, passed as part of the Affordable Care Act, targets abuse, neglect, and exploitation of the elderly.

ACA
Signed into law in March 2010
Divisive landmark legislation
Lawsuits against the federal government
The focus is access, quality and cost containment of healthcare
Nearly 50 initiatives implemented over several years
Issues with the implementation of the individual insurance mandate effective January 1, 2014
Federal website did not work; millions could not enroll in a healthcare plan.

Table 2-1

ACA Major Provisions
Eliminate lifetime and unreasonable annual caps or limits on healthcare reimbursement with annual limitations prohibited by 2014.
Provide assistance for the uninsured with pre-existing conditions and prohibit denial of insurance coverage for pre-existing conditions for children.
Develop a temporary national high-risk pool for health insurance for individuals with preexisting conditions who have no insurance.
This ended with the opening of the Health Insurance Marketplaces on October 1, 2013
Extend dependent coverage up to age 26.

ACA
Establishment of www.healthcare.gov for consumers to access information about healthcare insurance.
This Health Insurance Marketplace was unveiled on October 1, 2013 so insurance enrollment could begin during open enrollment. Ends on March 31st: It did not work, resulting in a huge controversy
Create a reinsurance program for retirees who are not yet eligible for Medicare
Would end when the Marketplaces opened on October 1st

ACA Health Insurance Marketplaces
States would establish health insurance marketplaces so consumers can shop and compare prices for health insurance.
If states did not operate their own website, the citizens could use the healthcare.gov website established by the federal government.
Huge problems with its initial operation. Low enrollment in October, November, December. Huge overhaul of the website.
Enrollment has since increased.

ACA Health Insurance Marketplaces
Insurance plans must now offer a Summary of Benefits so consumers can compare health insurance plans
Insurance plans must offer essential health benefits such as outpatient services, emergency services, laboratory services, preventive services, prescription drugs
Fines are levied if individuals do not purchase health insurance